New Membership Application

Affiliate Membership

R1000.00 excl. VAT

monthly

Associate Membership

R3000.00 EXcl. VAT

monthly

Full Membership

R5000.00 EXCL. VAT

monthly

Membership Package

Company Details

Registered Name of Organisation

Trading Name

Holding Company Name (if applicable)

Organisation Registration Number

Country of Registration

Contact Person First Name

Contact Person Last Name

Date Established

Date of Registration

Core Business

Company Address Details

Street Name / Box Number

Suburb

City

Postal Code

Physical / Delivery Address

Street Name

Suburb

City

Province

Postal Code

DEFINITION OF AUTHORISED REPRESENTATIVE

Title

First Name

Last Name

Preferred Name

ID Number

Date of Birth

Gender

Email Address

Telephone

Mobile

Department

Current Position

Date appointed in current position

BILLING INFORMATION

Title

First Name

Last Name

Current Position

Email Address

Telephone

Mobile

Fax

Prefered Currency

Require Order Number

YES - Order Number Required NO - Order Number Required

VAT

The information set out in this submission is true and correct to the best of my knowledge.

The above organisation abides by the Vapour Products Association of South Africa (VPA), and Code of Conduct.

I undertake, on behalf of the above organisation, to ensure payment of any fees due to VPA.

I understand that the organisation will remain a member of VPA until such time as a valid resignation is submitted to and received by VPA, or membership is withdrawn by VPA.

The above organisation meets the criteria for VPA Membership.

New Membership Application

Affiliate Membership

R1000.00 excl. VAT

Associate Membership

R3000.00 EXcl. VAT

Full Membership

R5000.00 EXCL. VAT

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